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ORIGINAL ARTICLE  
Year : 2014  |  Volume : 7  |  Issue : 1  |  Page : 43-47
Breakfast skipping and proposed effects of breakfast on obesity: A school based study in adolescents in Aligarh, India


Department of Community Medicine, JN Medical College and Hospital, Aligarh, Uttar Pradesh, India

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Date of Web Publication20-Nov-2014
 

   Abstract 

Background: Breakfast is one of the most integral components of an individual's diet, despite that breakfast skipping is widely prevalent. Proposed effects of breakfast on obesity (PEBO) have corroborative evidences from different countries, especially, regarding the effects of breakfast skipping on obesity. Habits and lifestyle factors like breakfast skipping maybe formed, changed or strengthened in the tender age of adolescence and can also serve as an early warning system of threats that may engulf larger populations. The study objectives were to find out the frequency of breakfast skipping in adolescents and PEBO, including associations with body mass index (BMI) status. Materials and Methods: This was a cross sectional study conducted in all the 13-15 years students who fulfilled the inclusion criteria in the schools affiliated to Aligarh Muslim University. The study was based on a pretested and validated questionnaire and the nutritional status/anthropometric records were measured by the now recommended World Health Organization multicentric growth reference standards 2007. Result and Conclusion: A total of 1416 students were studied, out of which frequency of breakfast consumption was found to be <2 times/week in 6. 21% of the study population, 3-5 times/week in 27.54% and 6-7 times/week in 66.24%. As far as PEBO is concerned, a decreased frequency of breakfast was found to have an association with obesity and overweight as well. Further, an association of breakfast skipping on the BMI Z scores was also found to be significant on analysis of variance and post-hoc tests. The high prevalence of breakfast skipping in India and PEBO is a big cause of concern for multiple reasons, and an intervention is urged.

Keywords: Adolescents, anthroplus, breakfast, obesity, proposed effects of breakfast on obesity

How to cite this article:
Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: A school based study in adolescents in Aligarh, India. Ann Trop Med Public Health 2014;7:43-7

How to cite this URL:
Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: A school based study in adolescents in Aligarh, India. Ann Trop Med Public Health [serial online] 2014 [cited 2019 Nov 13];7:43-7. Available from: http://www.atmph.org/text.asp?2014/7/1/43/145011

   Introduction Top


Breakfast is one of the most integral components of an individual's diet and plays an important role in ensuring the good health and wellbeing of an individual. [1] Despite the proven importance of this meal, it has been observed that it is often underrated and skipped, especially among the adolescents. Breakfast skipping is highly prevalent in many countries including the United States and Europe (10-30%), depending on the age group, reportedly being a more common occurrence in the children and adolescents. [2] The main reasons for skipping breakfast seem to be related to: Lack of time, lack of morning appetite, and for adolescents, concern about their body weight. [1] Concern about body weight as a reason for skipping breakfast is particularly a worrying trend as it is contradictory to what the research say, as breakfast skipping has been associated with increased prevalence of obesity rather than weight loss. Contrary to the evidences, skipping breakfast is perceived and practiced for weight loss by many people across countries, [3],[4],[5],[6] including school going adolescents. [7]

Proposed effects of breakfast on obesity (PEBO) have corroborative evidences from different countries, especially, regarding the effects of breakfast skipping on obesity. Obesity was reportedly found to be higher in breakfast skippers in studies conducted in Sweden, [8] Canada, [9] the enKid study in Spain, [10] Saudi Arabia, [11] Fiji [12] and other countries. Breakfast leads to beneficial alterations in the appetitive, hormonal, and neural signals that control food intake regulation [13] and this may be the reason behind PEBO.

The World Health Organization (WHO) has described obesity as one of today's most neglected public health problems. [14] Obesity in children and adolescents is gradually becoming a major public health problem in many developing countries including, India. [15],[16] The problem of obesity in India is not only found in the metropolitan cities [16] but even in the smaller cities like Surat, [17] Mysore, [18] Thrissur [19] and others. [20] A substantial impact on public health could be achieved if other factors causing obesity besides the conventional ones of diet and physical activity could be identified and acted upon [21] and that makes this area vital for research.

As a stage of life, adolescence is considered a specifically vulnerable time in the life of an individual; marked by transitions in nutrition, psychological behavior, sexual development, lifestyle and other arenas of life. Habits and lifestyle factors like breakfast skipping maybe formed, changed or strengthened in this tender age. Therefore, surveillance of the adolescent health and lifestyle profile of these young people can also serve as an early warning system of threats that will ultimately engulf larger populations. [22] Adolescence is a time in life that harbors many risks and dangers, but also one that presents great opportunities for sustained health and wellbeing through education and preventive efforts [23] and this makes this age group very pertinent for research and intervention in order to achieve a long-term control in the problem of obesity. Despite these important factors, there is a dearth of studies related to frequency and trend of breakfast skipping in adolescents in India and PEBO specifically.

The present study was conducted in school going adolescents of Aligarh in the age group of 13-15 years, as part of a larger study based on the WHO Global School Health Survey (GSHS). The city of Aligarh is in Uttar Pradesh, the most populated state of India according to the national Census. The study objectives were to find out the frequency of breakfast skipping in adolescents and PEBO, including associations with body mass index (BMI) status.


   Materials and Methods Top


Design

This research was a cross sectional study conducting a 1-time assessment of nutritional status and frequency of breakfast intake/week.

Duration


The study was conducted over a period of 6 months, from November, 2011 to April, 2012.

Setting

The study was held in three different schools of Aligarh, all of which are affiliated to the Aligarh Muslim University Board of Examination. In terms of numbers, these were among the largest schools of Aligarh. A prior permission was taken from the school authorities.

Study population

The study population comprised of students aged between 13 and 15 years enrolled in the aforementioned schools.

Sampling

All the students who were in the age group of 13-15 years and who gave the consent were recruited for the study.

Study instruments

The study instruments comprised of a proforma, a weighing scale, measuring tape to measure the height. The students were measured in minimal clothing and standing height was used.

The proforma consisted of questions on particulars of the participants and the usual frequency of breakfast per week. The frequency of breakfast per week was calculated on the basis of two questions - Q1. In a usual week, how many times/week do you take your morning breakfast? Q2. In the past week, how many times did you take your morning breakfast? The final answer or frequency of breakfast per week was calculated as Q1 + Q2/2. The questionnaire was pilot tested and validated before the actual research.

The nutritional status/anthropometric records were measured by the now recommended WHO multicentric growth reference standards (WHO MGRS) 2007. [24] For the ease of the users of these standards, the WHO recommends a software called as WHO AnthroPlus software which was used in this study.

Anthropometric measurements of weight, standing height, were recorded using standard techniques as prescribed. [25] Weight was measured in an upright position to the nearest 0.1 kg using calibrated Salter's weighing balance. Height was measured without shoes in minimal possible clothing to the nearest 0.1 cm using calibrated stadiometer. BMI for age Z scores (BMIZs) were used to define overweight and obese. Among the other precautions taken up during the study were regular calibration of instruments and recording date of birth from the written records (school register). Those students whose BMIZ values were flagged off (Z score ± 5) by WHO AnthroPlus during the data entry or were found to have extreme values were revisited within 2 days, and anthropometry was repeated.

Ethical issues

The study was approved by the multidisciplinary Institutional Board of Studies. Appropriated counseling, health education, balanced diet and breakfast and nutrition advice was offered to all the participants. Those who were in need of referral were referred to the JN Medical College, Aligarh.

Definitions

Overweight


Any adolescent having body mass for age-Z score more than + 1 standard deviation (SD) in WHO Reference (equivalent to 85 th percentile), was taken as overweight, as per WHO Reference standards 2007 (WHO Anthroplus).

Obese

Any adolescent having body mass for Age-Z score more than + 2 SD in WHO Reference (equivalent to 97 th percentile), was taken as overweight, as per WHO Reference standards 2007 (WHO Anthroplus).

Data management and processing

A total of 1416 students were sampled and studied. The weight and height were entered in the WHO AnthroPlus on the day of the visit. AnthroPlus was used to find the Z scores (based on WHO MGRS-2007 for that age and gender. Statistical Product and Service Solutions (IBM SPSS Statistics) version 20 was used to find out the relation between frequency of breakfast intake including breakfast skipping and overweight/obesity and other statistical calculations. IBM SPSS Statistics was used by the authors through the academic research facilities provided by the Aligarh Muslim University (AMU) for use in the campus. For further details, Computer Cell, AMU may be contacted.


   Results Top


A total of 1416 adolescents were sampled for this study, 712 males and 704 females. The frequency of breakfast consumption was found to be <2 times/week in 6. 21% (88/1416) of the study population, 3-5 times/week in 27.54% (390/1416) and 6-7 times/week or regular breakfast takers in 66.24% (938/1416). Among the various age groups, the frequency of breakfast consumption was significantly lower (P = 0.03) in 14 year olds, <2 times/week in 8.9% (44/495), 3-5 times/week in 25.4% (126/495) and 6-7 times/week in 65.7% (325/495) as compared to the 13 year olds and 15 year olds. In the 13 year olds the frequency was 5.0% (23/463), 27.4% (127/463), and 67.6% (313/463) respectively in those who had breakfast <2 times/week, 3-5 times/week and 6-7 times/week; which was 4.6% (21/458), 29.9% (137/458) and 65.5% (300/458) in the 15 year olds respectively. There was no significant difference between males and females as a whole in terms of frequency of breakfast consumption. The details of the prevalence rates of breakfast consumption are given in [Table 1].
Table 1: Prevalence rates of breakfast consumption in the study population

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The prevalence of overweight and obesity were found to be 12.3% (174/1416) and 2.3% (33/1456) respectively, in the study population, and a significant association (P = 0.001) was found between frequency of breakfast consumption and being overweight/obese as compared to being normal. The details of the association and Chi-square test are mentioned in [Table 2].
Table 2: Association of breakfast consumption with overweight/obesity

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On further analysis, it was found that the odds of being either overweight or obese was significantly higher in those who reported their frequency of breakfast as <2 times/week (odds ratio [OR] = 3.44, 95% confidence interval [CI]-2.08-5.68) or 3-5 times/week (OR = 2.08, 95% CI-1.51-2.87), as opposed to those who had it regularly or almost regularly (6-7 times/week). Apart from being overweight and obese, which we define at more than + 1 SD and + 2 SD, we also tried to find out whether the frequency of breakfast consumption also had an effect on Body for Mass Index Z scores (BMIZ) of the study population at large, as highlighted in [Table 3].
Table 3: Relation of frequency of breakfast consumption with BMIZ

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On analysis of variance testing, there was a significant effect of consumption of breakfast frequency on BMIZs at the P < 0.05 level for the three conditions, breakfast consumption <2/week, 3-5 times/week and 6-7 times/week (F {2, 1413} = 391.56, P = 0.001).

Further, Post-hoc comparisons using the Tukey honest significant difference test indicate that the mean BMIZ score for frequency of breakfast consumption <2 times/week (M = 1.11, SD = 0.56) was significantly different than those with breakfast consumption frequency 3-5 times/week (M = 0.57, SD = 0.59) and 6-7 times/week (M = −0.42, SD = 0.77) with a P = 0.001 in both the cases. Taken together, these results suggest that having different frequencies of breakfast consumptions have a significant effect on BMIZ score. Thus, lower the frequency of breakfast consumption, higher the chances for having a high BMIZ and in turn being overweight/obese; and hence, PEBO is found to be significant with breakfast skipping (<2 times/week) and even lower frequency of breakfast intake (3-5 times/week).


   Discussion Top


This study concludes that almost 33.8% (478/1416) adolescents in the schools of Aligarh do not take their breakfast regularly, and therefore is a point of concern, as breakfast is one of the most important diet that an individual takes as discussed. The rates of breakfast skipping in the US and Europe, range from 10% to 30% (2), which is similar if not higher than that found in our study, in India.

As far as PEBO is concerned, the frequency of breakfast has been found to have a definitive impact on not only obesity but also when obesity and overweight were taken together. The odds' were found to be higher for those who took the breakfast at a frequency of <2 times/week as compared to the ones having it for 3-5 times/week. Thus, the findings are akin to the other studies in different parts of the world, as discussed elsewhere in the paper. [8],[9],[10],[11]

Further, an association that the different frequencies of breakfast skipping have on the BMIZ scores was also found to be significant. The E-MOVO project involving 35,000 Dutch secondary school students [26] also found a similar association that breakfast frequencies have on BMI, as did Berkey et al. in their study in the US. [27]

The high prevalence of breakfast skipping in India and the corroborative evidence for PEBO is a big cause of concern for many reasons. Firstly, the country has an enormous adolescent population and this high rate of breakfast skipping taking PEBO in consideration, does not augur well for a healthy future. Secondly, this study was not conducted in a metropolitan city but a smaller one! These lifestyles can be more adverse in the bigger cities of India as they are a part of the lifestyle that is being imported from the so called developed countries of the world, which are usually higher in the metropolitan cities. Thirdly, as obesity is often considered as the first wave of the new world syndrome, the habit of breakfast skipping in the adolescents if checked and addressed, at this stage of life, can be of a beneficial value in the future.


   Conclusion Top


The study was aimed at finding the frequency of breakfast intake in the school going adolescents and PEBO. It found out that there is a very high frequency of breakfast skipping and that the frequency of breakfast intake has a significant association with the prevalence of overweight and obesity. The odds' of being overweight/obese was found to be 3.44 in those having breakfast <2 times a week and 2.08 in those taking it 3-5 times/week, as compared to the ones having it regularly or almost regularly (6-7 times/week). The BMIZ mean was also significantly more for both the breakfast skipping frequencies with each other and with the regular/almost regular breakfast takers. Health education for parents in this regard and practicing the habit of taking daily breakfast, may be together as a family if possible is also advised.

Thus, the authors suggest that further research and evidence based intervention for obesity should also focus on this determinant of obesity as this habit is seemingly easier to manipulate as compared to the dietary behavior and physical activity profile at large which also depend on the availability of playgrounds and other resources for any change.

Limitations

The study also has a few limitations. There is no temporal relationship studied between breakfast skipping and obesity, as to which led to what, which is a usual disadvantage of all the cross sectional studies in general. Furthermore, the study is based on self-reports which might affect the correct frequencies of the breakfast intake, but there are no reasons to believe that the over weights and obese would have reported their frequency of breakfast intake significantly different than their otherwise normal counterparts. The research is also incapable of declaring any causal relationship between breakfast intake and overweight/obesity/BMIZs. Another limitation of this study was that this was a study based on WHO-GSHS pattern; and therefore included only 13-15 years adolescents and not the whole of the adolescent population in the classical sense.

 
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Correspondence Address:
Nafis Faizi
B-8, Sami Apartments, Dodhpur, Civil Lines, Aligarh - 202 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.145011

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